As caretakers of children, family and community, it was natural that women were the nurses, the caregivers, as human society evolved. Nursing may be the oldest known profession, as some nurses were paid for their services from the beginning. This was especially true of wet nurses, who nursed a baby when the mother died or could not nurse her child. A woman whose infant did not survive birth, or who was ready to wean her child, or who was capable of nursing more than one baby, would accept employment as a wet nurse, usually going to live in the home of her employer.
The home, in fact, was the center of health care, and for the first two centuries after European exploration of North America, all nursing was home nursing. Even when the nation’s first hospital began in Philadelphia in , it was thought of primarily as an asylum or poorhouse; another century or more would pass before the public viewed hospitals as reputable and safe.
The Civil War gave enormous impetus to the building of hospitals and to the development of nursing as a credentialed profession. Initial wartime volunteers, however, often were seen as no different from “camp followers,” the women (sometimes mistresses and sometimes wives) who followed their soldier men. It was an era of sharp class definitions, and especially in the South, “respectable” women could not be seen in a military hospital.
Some women had the courage and common sense to defy decorum, though, especially in the North, where the US Sanitary Commission became the forerunner to the Red Cross. The best known of these women, of course, is Clara Barton—but her genius was in supply distribution and in development of systems for the missing and dead, not in nursing. Barton herself acknowledged that she actually nursed for only about six months of the four-year war and that other women did much more.
Mary Ann Bickerdyke
Perhaps the best known nurse at the time, was Mary Ann Bickerdyke of Illinois. A middle-aged widow, her accidental career began when she delivered money raised by local charities to the giant, if temporary, hospitals that the Union built at the junction of the Mississippi and Ohio rivers. After witnessing suffering soldiers who had literally no one to care for them, she went on to be the only woman that General William T. Sherman allowed with his army. At the Tennessee battle of Lookout Mountain, she was the sole nurse for some two thousand men.
In the Confederacy, the most prominent nurses were Captain Sally Tompkins and Phoebe Pember. Tompkins was commissioned as an officer in the Confederate army so that she could have the power to commandeer supplies. She converted her Richmond mansion into Robertson Hospital and established a reputation for extraordinary quality: Tompkins’ hospital had by far the lowest death rate of any facility in the North or South, even though physicians sent their worst cases to her. Her staff of six—four of whom were black women still in slavery—treated more than 1, patients and lost only 73, an uncommonly low number in an era before germ theory was understood.
Phoebe Levy Pember c.
Phoebe Levy Pember has become somewhat better known since the Post Office recently included her on a series of Civil War stamps. A young widow from a wealthy, Jewish family based in Charleston and Atlanta, she went north to the Confederate capital of Richmond and eventually ran the world’s largest hospital. On an average day, Pember supervised the treatment of 15, patients, most of them cared for by nearly slave women.
The war thus led to greater respect for nurses, something that Congress acknowledged in , when it belatedly passed a bill providing pensions to Civil War nurses. More important, the war served as the beginning of moving the profession from the home to the hospital and clinic. The result was an explosion of nursing schools in the late nineteenth century. Usually these schools were closely associated with a hospital, and nurses—all of whom were assumed to be female—lived and worked at the hospital.
Often called “sisters” (as British nurses still are), their lives were indeed similar to those of nuns. Forbidden to marry, they were cloistered in “nurses’ homes” on hospital grounds, where every aspect of life was strictly disciplined. Student nurses were not paid at all, and because too many hospitals valued this free labor over classroom and laboratory time, many spent their days scrubbing floors, doing laundry, and other menial tasks. Curricula improved, however, in part because of the development of a tradition with caps: each nursing school had a distinctive cap that women wore after graduation, and because her educational background was literally visible every day, schools soon raised standards so that their graduates would affirm their quality.
There were more female physicians (and hospital administrators) during the 19th century than most people realize today—and some of these female physicians recognized the need for nurses and worked to professionalize the occupation. Dr. Marie Zakrewska founded a medical school for women in Boston that was affiliated with her New England Hospital for Women and Children in , during the Civil War—and a decade later, in , she began an associated nursing school that was the nation’s first.
Linda Richards c.
Linda Richards was its first graduate and thus is known as America’s first professionally trained nurse. Richards went on to establish her own precedent-setting programs as superintendent of nursing at New York’s Bellevue Hospital and at Massachusetts General Hospital; she also set up the first nursing school in Japan.
Like most educational institutions at the time, these schools did not admit African Americans, and the informally trained black women who nursed during the Civil War seldom were able to obtain credentials. The first credentialed black nurse was Mary Mahoney, who graduated in from Dr. Zakrewska’s nursing school in Boston. As segregation remained the rule far into the 20th century, Mahoney led the National Association of Colored Graduate Nurses, which began in
During the four decades between the Civil War and the beginning of the twentieth century, the image of nurses moved from being viewed as somewhat less than honorable to a respected profession. The next century would bring still more changes, and nurses of the 19th century would scarcely recognize the occupation as it is in the 21st century. They would, however, agree that a world of difference has occurred in the care of patients, and that has been an unmitigated good—achieved primarily by women.
Students with disabilities are increasing in number at nursing schools throughout the world. Although they may initially encounter discrimination and other obstacles, students with hearing loss, vision loss, paralysis, learning disabilities, mental illness, chronic illness, limb differences and other disabilities have been not only been admitted to nursing programs but have successfully completed them.
If you are someone who loves helping others, nursing is one of the most rewarding careers you could consider. But if you are also a person with a disability, there is important “homework” to do before you make the decision to become a nurse. Nursing is a physically and emotionally demanding educational experience and profession. As you complete your homework, make a list of the pros and cons. Your decision shouldn’t be based on what you “think” a nurse does or what you viewed on a television program. The best way to find out what nurses do is to spend some time with nurses. Learn as much as possible about a nurse’s responsibilities and the technical skills that nurses and nursing students typically perform.
You can gather this information by talking to nurses and nursing students, observing nurses at work, volunteering in a clinic or hospital, spending a day on the job with a nurse or working a part-time job in a health care facility. Doing volunteer work with a nurse at a camp for children with special needs or at a clinic for the homeless can also provide great insights. High school students should consider joining the future nurses organization at their school or taking a health occupations course and joining a chapter of the Health Occupations Students of America.
Additional information about what is involved in nursing careers can be obtained from colleges, universities, technical schools, libraries, nursing journals, nursing associations and the Internet. Some helpful Internet sites to visit include:
- The National Institutes of Health, dfknj.wz.cz, to learn about careers in health sciences.
- Discover Nursing, sponsored by Johnson Johnson, to learn about careers in nursing (dfknj.wz.cz).
- dfknj.wz.cz is a nonprofit resource network for nurses and nursing students with disabilities (dfknj.wz.cz).
- The Association of Medical Professionals with Hearing Losses (AMPHL), dfknj.wz.cz, provides information, advocacy and support for individuals with hearing loss who are interested in or working in health care fields.
Begin networking with nurses, nursing students or other health care professionals who have a disability similar to yours. Ask these contacts about their experiences and about accommodations that helped them succeed. Find a nurse or student who can mentor you. Do a library search and read all you can about the experiences of other nursing students with disabilities.
Know your rights under the Americans with Disabilities Act and the Rehabilitation Act. Be knowledgeable about reasonable accommodations and the differences in legal protections for students with disabilities in high school and in collegei.e., the differences between IDEA, ADA and Section
Keep abreast of new programs and developing technology, such as standing wheelchairs that will enhance mobility for nurses who use wheelchairs. Clear surgical face masks will allow a nurse to read lips when other members of the surgical team are wearing masks. (The development of clear face mask products is being monitored closely by the AMPHL.) The University of Salford, in England, opened the first nursing program for students who are deaf.
Understanding Admissions Standards
Another important part of your homework is learning about the different educational options available to prospective nursing students and about how to navigate the nursing school admissions process.
There are several different types of nursing programs offered. Registered nurses (RNs) are educated in baccalaureate degree programs (bachelor of science in nursing or BSN), two-year associate degree programs and three-year hospital diploma programs (rare in the United States). Licensed practical nurses (LPNs) are educated in technical schools and community colleges. In general, a BSN program is usually less focused on technical skills.
There are no universal standards for admission to nursing programs, and requirements under state Nursing Practice Acts can vary from state to state. Furthermore, admission decisions can differ from program to program and can be dramatically inconsistent. The same student can be rejected at one school and welcomed at another. Decisions will be made on a case-by-case basis.
Some nursing programs have technical or core performance standards. Examples may include critical thinking, interpersonal skills and communication, mobility, motor skills, hearing, visual and tactile skills. Other programs may have more specific standards, such as being able to lift 25 pounds, physical ability to perform CPR, hearing ability to understand normal speech without viewing the speaker’s face, and manual dexterity to draw up solutions in a syringe.
It is important to recognize that even though you may have a career goal of working in an area of nursing that does not require direct patient caresuch as case management, research or teachingyou must still complete nursing courses that will require you to demonstrate a wide range of technical skills, including some that you may not plan to use after you graduate.
If you will need accommodations for your disability in nursing schoolsuch as special equipment, a sign language interpreter, books on audiotape or someone to take notes for youyou will need to provide documentation from your physician, audiologist, psychologist or other health care professional.
Above all, be prepared, be prepared and be prepared. Anticipate a wide range of responses to your disability from administrators, faculty, other students and patients. To deny that you may meet with a negative attitude or response isn’t being fair to yourself or realistic. The important thing is to move forward with your head held high.
Rehearse Your Responses
Mentally rehearse responses to questions you may be asked during nursing school admissions interviews. Always focus on your positive attributes, previous accomplishments and life experiences. Be professional and enthusiastic. Practice interviewing by having someone role-play with you.
You may be asked about how you will perform technical skills with or without accommodations. Some skills you may not be familiar with. Be honest in your responses. Keep the following examples of questions and answers in mind as you plan for interviews.
- A student who uses a wheelchair might be asked, “How will you perform CPR?” Sample answer: “First, I will call for help, which is the first recommendation of the American Heart Association when working with adults. Then, I will get up out of my wheelchair. It’s not something that I use all the time; in an emergency like CPR, I would not use the wheelchair.”
- A student with one hand might be asked, “How will you give an injection?” Sample answer: “I have developed excellent compensatory abilities and can be creative when learning new skills. I learned to tie my shoes with one hand when I was four years old. When I am required to learn or demonstrate how to give an injection, I will seek extra assistance from the laboratory instructor and practice different methods.”
- A student with low vision might be asked, “How will you read a medical chart?” Sample answer: “I will use an optical reading aid.”
- A student with a back injury and lifting restrictions might be asked, “How will you make a bed or turn a patient in bed?” Sample answer: “I will ask a colleague/peer for help. In return, I will negotiate work that I can do to help my colleague/peer out.”
- A student with hearing loss might be asked, “How will you hear a patient’s beeping monitor?” Sample answer: “I’ve never worked in a hospital. I don’t know if I will be able to hear the monitors. I may need assistive technology that will activate my vibrating pager when a monitor beeps.”
- A student with hearing loss may also be asked, “Will you be able to hear the sound of a needle penetrating a patient’s skin?” Answer: “No, I won’t be able to.” (You may be asked this type of question to see if you will respond honestly.)
These examples are not meant to be verbatim responses that applicants should use, unless the response is appropriate. They are included simply as examples of answers that are honest and show that the applicant has researched or thought about the topic.
Go For It!
The future promises to find more and more nurses with disabilities working successfully in this exciting and fulfilling profession. Nurses can practice in a wide variety of settings, such as telephone triage, nursing education, home care, legal nurse consulting, case management, hospital nursing, school nursing, camp nursing, travel nursing, parish nursing, research and more. If you know in your heart that nursing is what you want to do, then do your homework…and go for it!
Today’s nursing workforce needs practitioners from a diverse range of cultures, backgrounds and life experiences to meet the needs of an increasingly diverse patient population, both in the U.S. and around the world. We need you in the ranks of nursing professionals, where you will be a vital part of the health care team. Through your unique contributions and strengths, you will enrich patient care, share your gifts and experiences, and add greater harmony to our profession.
Editor’s Note: In the Summer issue of Minority Nurse, the authors will examine what nursing schools can do to make their programs more welcoming to students with disabilities and to help these minority students become successful members of the nursing profession.
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2. Chickadonz, G.H., Beach, E.K., and Fox, J.A. (). “Breaking Barriers: Educating a Deaf Nursing Student.” Nursing Health Care, Vol. 4, No. 6, pp.
3. Creamer, B. (). “Wheelchair Fails to Deter Paraplegic from Nurse’s Life.” The Honolulu Advertiser. Available at dfknj.wz.cz
4. Eliason, M. (). “Nursing Students with Learning Disabilities: Appropriate Accommodations.” Journal of Nursing Education, Vol. 31, No. 8, pp.
5. Huyer, S. (). “The Gift of ADD.” Advance for Nurse Practitioners, Vol. 11, No. 4, p.
6. Kolanko, K. (). “A Collective Case Study of Nursing Students with Learning Disabilities.” Nursing Education Perspectives, Vol. 24, No. 5, pp.
7. Maheady, D. (). “Jumping Through Hoops, Walking on Eggshells: The Experiences of Nursing Students with Disabilities.” Journal of Nursing Education, Vol. 38, No. 4, pp.
8. Pischke-Winn, K., Andreoli, K., and Halstead, L. (). Students with Disabilities: Nursing Education and Practice (Proceedings Manual). Rush University College of Nursing.
9. Americans with Disabilities Act (), Public Law, No. , 42 U.S.C.
Matt, S.B. (). “Reasonable Accommodation: What Does the Law Really Require?” Journal of the Association of Medical Professionals with Hearing Losses, Vol. 1, No. 3.
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